Provider Demographics
NPI:1194517789
Name:PAGE, MARY ANNE (PT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANNE
Last Name:PAGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 VAN BUREN RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-3588
Mailing Address - Country:US
Mailing Address - Phone:207-498-1174
Mailing Address - Fax:207-498-1149
Practice Address - Street 1:163 VAN BUREN RD STE 1
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-3588
Practice Address - Country:US
Practice Address - Phone:207-498-1174
Practice Address - Fax:207-498-1149
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1254225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist